TL QA Auditor

HealthFirst•Hybrid - FL, FL

5d•$73,400 - $120,360•Hybrid

About The Position

The Quality Audit (QA) Team Lead is responsible for managing the daily activities of the Quality Audit Team. The QA Team Lead is also responsible for performing internal quality audits of operational processes for internal employees and outsourced vendors to ensure compliance with policies, procedures, and quality standards. The incumbent will oversee the team, investigate, audit, and conduct root cause analysis. The individual at this level will embody Healthfirst’s Culture Drivers through their workplace behavior.

Requirements

High school diploma or GED
Strong claims knowledge and internal process knowledge preferred.
Quality Assurance/Auditing experience (1-2 years)
Experience in Microsoft Office suite of applications including Excel (formatting formulas, managing data, and filtering results), Word (creating and editing documents), PowerPoint (creating and editing presentations).
Proficiency in using Claims processing systems (preferably MHS)

Nice To Haves

Associate or Bachelor’s degree from an accredited institution
Experience in an audit capacity conducting audits and root cause analysis. (3-5 years)
Experience in Performance Management and employee coaching.
Proven ability to handle multiple assignments, projects, and deliverables.
Knowledge of at least two or more lines of business such as Medicare NY/NJ, Medicaid, Family Health Plus, Child Health Plus, NH Family
Experience handling confidential information.
Strong time management and Interpersonal skills

Responsibilities

Manages a team of quality auditors, with the responsibility for monitoring inventory and productivity, coaching and providing feedback, performance management and other leadership responsibilities as assigned.
Conducts regular 1x1 meetings to understand the team’s needs and barriers.
Delivers Develops training materials for employees as needed and ensures new hires and existing are on-boarded and trained accordingly.
Partners with internal business partners and vendors to discuss topics related to quality audit results, processes, and improvements to help drive consistency of the audit processes.
Participates in /facilitates in quality calibration sessions.
Partners with leadership and HR (as needed) on people initiatives including performance management, compensation planning, staffing, employee relations concerns/issues, and staffing.
Makes critical decisions in support of the department as needed.
Communicates effectively to hand-off and pick-up work from business partners and vendors.
Identifies defects and improves departmental performance by supporting quality, operational efficiency and production goals.
Assists in the development of departmental policies and procedures and reviews the efficiency of existing training.
Meets established time frames and rates of performance for the quality and quantity of work for the position.
Prepare reports to adequately document results, support department level and/or recommendations and ensure the timely delivery of reporting deliverables.
Assist with performing User Acceptance Testing (UAT), system enhancements, or projects in partnership with Business Operations
Prepare reports to adequately document results, support department-level analysis and/or recommendations, and ensure the timely delivery of reporting deliverables.
Other duties as assigned